Department of Obstetrics and Gynecology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
School of Medical Sciences, Faculty of Health and Medicine, Örebro University, Örebro, Sweden.
Acta Obstet Gynecol Scand. 2023 Aug;102(8):1034-1044. doi: 10.1111/aogs.14614. Epub 2023 Jun 20.
Obstetric anal sphincter injury is an important risk factor for postpartum fecal incontinence but few studies have reported fecal incontinence occurring, even during pregnancy. The first objective of this study was to examine the prevalence of fecal incontinence, obstructed defecation and vaginal bulging early and late in pregnancy and postpartum. The second objective was to assess the association between symptoms in pregnancy, delivery characteristics, and bowel and vaginal bulging symptoms at 1 year postpartum.
This prospective cohort study was conducted between October 2014 and October 2017, including 898 nulliparous women enrolled with the maternity healthcare service in Örebro County, Sweden. The women responded to questionnaires regarding pelvic floor dysfunction in early and late pregnancy and at 8 weeks and 1 year postpartum. The data were analyzed using random effect logistic models estimating odds ratios (ORs) and generalized linear models estimating relative risks, with 95% confidence intervals (CIs).
At 1 year postpartum, the prevalence of fecal incontinence, obstructed defecation and vaginal bulging was 6% (40/694), 28% (197/699) and 8% (56/695), respectively. Among women with vaginal delivery, the risk of fecal incontinence and vaginal bulging increased significantly both in late pregnancy, with ORs of 3.4 (95% CI 1.5-7.7) and 3.6 (95% CI 1.6-8.1), respectively, and at 1 year postpartum, with ORs of 5.0 (95% CI 2.1-11.5) and 8.3 (95% CI 3.8-18.1), respectively, compared with early pregnancy. Among all women, factors associated with increased prevalence of fecal incontinence 1 year postpartum were fecal incontinence during pregnancy (adjusted relative risk [aRR] 7.4; 95% CI 4.1-13.3), obstructed defecation during pregnancy (aRR 2.0; 95% CI 1.1-3.9) and concurrent obstructed defecation (aRR 2.4; 95% CI 1.3-4.5).
This prospective study shows an increased risk of fecal incontinence by late pregnancy, suggesting that the pregnancy itself may be involved in the development of postpartum fecal incontinence. Obstructed defecation during pregnancy and postpartum was found to be associated with increased risk of fecal incontinence postpartum, indicating that postpartum fecal incontinence may be a result of incomplete bowel emptying.
产科肛门括约肌损伤是产后粪便失禁的一个重要危险因素，但很少有研究报告在怀孕期间发生粪便失禁。本研究的第一个目的是检测早孕期、晚孕期和产后粪便失禁、排便困难和阴道膨出的发生率。第二个目的是评估孕期症状、分娩特征与产后 1 年时的排便和阴道膨出症状之间的关系。
本前瞻性队列研究于 2014 年 10 月至 2017 年 10 月在瑞典厄勒布鲁县的产科保健服务中进行，纳入了 898 名初产妇。这些女性在早孕期、晚孕期、产后 8 周和 1 年均回答了关于盆底功能障碍的问卷。采用随机效应逻辑模型估计比值比（ORs）和广义线性模型估计相对风险（RRs），置信区间（CIs）为 95%。
产后 1 年时，粪便失禁、排便困难和阴道膨出的发生率分别为 6%（40/694）、28%（197/699）和 8%（56/695）。在阴道分娩的女性中，晚孕期粪便失禁和阴道膨出的风险显著增加，OR 值分别为 3.4（95%CI 1.5-7.7）和 3.6（95%CI 1.6-8.1），产后 1 年时的 OR 值分别为 5.0（95%CI 2.1-11.5）和 8.3（95%CI 3.8-18.1），与早孕期相比。在所有女性中，产后 1 年粪便失禁发生率增加的相关因素包括孕期粪便失禁（调整后的相对风险 [aRR] 7.4；95%CI 4.1-13.3）、孕期排便困难（aRR 2.0；95%CI 1.1-3.9）和同期排便困难（aRR 2.4；95%CI 1.3-4.5）。
本前瞻性研究显示，晚孕期粪便失禁的风险增加，表明妊娠本身可能参与了产后粪便失禁的发生。孕期和产后的排便困难与产后粪便失禁风险增加有关，表明产后粪便失禁可能是由于不完全排空肠道所致。
